Ayurvedic Understanding of Dumping Syndrome

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Dumping Syndrome – It is a condition wherein the consumed food moves too quickly from the stomach to duodenum – the first part of the small intestine. One would experience symptoms like diarrhea and cramps within a few minutes to a few hours of taking food. It may also occur following stomach surgery wherein a part of stomach or whole stomach has been removed or in those who have had stomach bypass surgery to lose weight.

Dumping Syndrome is of two types. Early Dumping Syndrome is when the symptoms appear 10-30 minutes after taking food and comprises 75% of cases of dumping syndrome. Late Dumping Syndrome is when the emptying or dumping happens 1-3 hours after consuming the food and is found in less number of people in comparison to early dumping syndrome.

Related Reading – “Dumping Syndrome – meaning, causes, symptoms, prevention, treatment”

Though there is no one condition explained in Ayurveda which can be directly correlated with Dumping Syndrome, this article attempts to bring into focus many conditions explained in different contexts which have similar symptomatology and presentation as that of dumping syndrome. The mechanism of this condition happening has also been explained from the perspective of doshas governing the gastrointestinal tract.

Dumping Syndrome – Ayurveda Perspective

From Dosha Perspective

1. Early Dumping Syndrome – can be said to be caused by hyperactivity of samana vata and pachaka pitta. Pachaka pitta tries to digest the food in a hurry and samana vata pushes the food quickly from stomach into the intestine. Improperly digested food also stimulates the peristalsis in an exaggerated way. This can be correlated with high acids (pachaka pitta increase) excessively stimulating the nerves controlling the movements of the stomach and intestine muscles (samana vata) so as to push the food.

The functions of pachaka pitta include – anna grahana i.e. reception of food, pachana – digestion of food, vivechana – bifurcates the food into useful (nutrition) and unwanted (feces) portions and munchana – expulsion of digested food into the small intestine and unwanted portions from small intestine to colon. If the coordination between these functions of pachaka pitta is not proper, it can lead to symptoms mimicking dumping syndrome.

2. Late Dumping Syndrome – may be due to lazy (hypo-active) samana vata and pachaka pitta. Here the food is digested and pushed slowly from the stomach into the intestine. Initially the weak pitta digests the food slowly. The partially digested food gets stagnated for a long time. This food hinders the samana vata from pushing down the food into the intestine at the right time and hence delayed or late dumping occurs.

Both these conditions are called dumping syndromes because the stomach dumps the partially digested food into the intestine. The word ‘dumping’ is important here. This word differentiates the normal evacuation of digested food (physiology) from abnormal evacuation of undigested food (pathology).

Ayurveda diseases resembling with Dumping Syndrome and its subtypes

Early Dumping Syndrome – Looking at the symptoms of Early Dumping Syndrome, it can be included under two conditions explained in Ayurveda –

–        Visuchika
–        Adhmana

Late Dumping Syndrome – Though we cannot get closer conditions explained in Ayurveda texts to compare with Late Dumping Syndrome, some of the symptoms closely resemble that of Visuchika. Visuchika is a condition caused by indigestion and is often compared to cholera.

This condition can also be compared to yet another condition named ‘Alasaka’ – a digestive disorder explained in Ayurveda caused by indigestion. Alasaka means lazy. Here the stomach is lazy. The food gets stagnated for a pretty long time in the stomach and doesn’t get eliminated in an upward or downward direction. The food doesn’t get easily digested in this condition. This can be considered as late dumping. In alasaka there occurs distension and sounds in the abdomen, there is absolute constipation (feces and fart are not eliminated) which also causes thirst and belching. These symptoms are not evident in late dumping syndrome. But the symptoms evident in late dumping syndrome may be considered as after-effects of indigestion and absolute constipation.

Related Reading – Alasaka

Another condition called as Vilambika caused due to indigestion of food, caused by contamination of food by vitiated kapha and vata resembles late dumping syndrome from the perspective of description of the disease. But Vilambika is said to be incurable and hence doesn’t fit into the comparison with late dumping syndrome.

Related Reading – Vilambika

Role of Vishamagni

The agni influenced by vata is called vishamagni. Vishama means unpredictable or severely varying. This digestive fire behaves as weirdly as vata. Sometimes the person experiences good hunger and sometimes absolutely nil. Sometimes this fire digests the food properly and sometimes not at all. This also may influence how the bowel evacuates the wastes (feces). There may be easy evacuation sometimes and sometimes difficult. This behavior of vata would cause a confused clearance in the gut. Vishamagni, due to its unpredictable nature, causes both early and late dumping syndrome.

The Samana Vata perspective

Samana Vata is a subtype of vata which is located in the gut, very close to the agni – the digestive fire. In its balanced state, it helps in keeping the agni in a state of balance. When it gets imbalanced it can disturb the agni to varied proportions.

The functions of Samana Vata include –

Annam Grihnati (Anna Dharana– Vagbhata) – Samana Vayu is located in the stomach, near the seat of agni – digestive fire and closer to the pitta located therein i.e. pachaka pitta. The combined action of these doshas along with buffering and softening role of kledaka kapha enables easy digestion of food and passage of digested food to the next part of the digestive tract. Samana Vata initially receives the food i.e. permits the entry of food into the stomach. So, the environment for reception of foods and drinks we consume is kept ready by samana vata in a state of its balance. Prana Vata and Udana Vata take part in this process and help Samana Vata to receive the food. Samana Vayu also helps in retention of the food in the stomach until it is digested to a particular extent. If this is not accomplished due to the sluggishness or hyperactive nature of samana vata, the food gets propelled from the stomach quickly into the loser intestines without getting properly digested. This leads to the manifestation of many disorders due to sluggish and improper / incomplete digestion of food. This includes dumping syndrome.

Annam Pachati – Samana Vayu is said to be located in the proximity of Agni i.e. digestive fire. The fire is represented in the body by pitta. The pitta in this context is Pachaka Pitta – located in the stomach and intestines. The Samana Vayu and Pachaka Pitta (Agni) are always interrelated and always work in coordination with each other and are involved in proper digestion of food. The chemistry between these two is very important. The coordination of samana vayu with the local doshas in the stomach and intestines i.e. Pachaka Pitta and Kledaka Kapha and the balance between them is of utmost importance. Many pathological conditions and functional imbalances like Dumping Syndrome can manifest when this chemistry, coordination and balance is disturbed.

Annam Vivechayati – Samana Vayu takes part in bifurcation of food into sara bhaga i.e. digestible / digested part and kitta bhaga i.e. undigested or excretory part. Sara Bhaga is the part of food which is needed for the building and functioning of body and mind i.e. nutritive part and Kitta Bhaga is the unwanted portion or wastes / excreta of the food. The segregation of food into these components is a basic internal gut intelligence provided by Samana Vayu. Without this intelligence, the body would throw or excrete everything that we eat or hold within the stomach and intestines. This would eventually harm the body in many ways. After receiving, digesting and bifurcation of food, Samana Vayu prepares the sara bhaga to get absorbed and to be distributed all over the body to all the cells and organs of the body through the heart, with the help of Vyana Vayu. On the other hand, it prepares the unwanted / excretory components i.e. kitta bhaga to get excreted from the body. It further bifurcates the kitta bhaga portion into pureesha – feces, mutra – urine and sweda – sweat. If this bifurcation is not carried over properly by Samana Vayu, the food will quickly be dumped into the lower small intestines and large intestines, which will be responsible for dumping syndrome and its symptoms.

Annam Munchati (Kitta Adho Nayana – Vagbhata) – Samana Vayu helps in propelling or pushing the kitta bhaga i.e. excretory wastes in downward direction, towards the large intestine so that they get excreted with the help of Apana Vayu. Though Apana Vayu is mainly responsible for excreting the wastes out of the body, Samana Vayu helps in preparing the wastes and holding it until they are expelled by Apana Vayu. Inadequate or hyper functioning of Samana Vayu can cause late and early dumping syndromes respectively.

Diseases caused due to vitiation or imbalance of Samana Vayu include

गुल्म अग्नि साद अतीसार प्रभृतीन् कुरुते गदान्।(सु.नि.१)

–        Gulma – Abdominal tumors
–        Agnisada – Indigestion / sluggish digestion / anorexia
–        Atisara – Diarrhea
–        Prabhrtin Gadan – Other dreadful diseases

Some of these conditions are associated with dumping syndrome.

Aushadha Sevana Kala for Samana Vata Balancing

Special time of administration of medicines to bring about balance of samana vata / to treat diseases caused by imbalance of samana vata –

Madhyabhakta (in between the meals) – To bring about balance of samana vata and also cure the diseases caused by aggravated samana vata, medicines shall be administered in between the meals.

Method of administration of medicines – First, one has to consume half the quantity of the food. Then he has to take the medicine. Later he shall consume the remaining part (half) of the food. This is called as madhyabhakta procedure of taking the medicine.

This form of taking the medicine will balance samana vata and cure the diseases caused by the imbalance of the same. This mainly stimulates samana vata and hence enhances the digestive fire (capacity). Therefore, it is a cure for sluggish digestion and indigestion. It is also a good remedy for the diseases of the abdominal organs, diseases of the colon, colic, abdominal tumors and sprue / irritable bowel (inflammatory bowel disease).

Medicines antagonistic to aggravated vata and those which help in kindling and balancing the digestive fire shall be administered in this method to cure dumping syndrome.

Role of Apana Vayu

As already said, Apana Vayu is mainly responsible for excretion of metabolic wastes. But the initial process of preparing mala – excreta from the food and pushing it from the stomach to the colon is the function of Samana Vayu. When the coordination between these two Vayus is disturbed, many gastrointestinal conditions like Dumping Syndrome may occur.

When Apana Vayu is hyperactive and conditions like diarrhea, irritable bowel syndrome etc. occur, the stomach and upper intestines wherein Samana Vayu is operational is influenced, it causes early dumping syndrome due to the suction activity of Apana Vayu. At the same time, hypo functioning of Apana Vayu may cause conditions like constipation and udavarta – upward movement of vata which in turn causes upward pressure over the Samana Vayu zone and might cause late dumping syndrome.

Causative Factors

Below mentioned etiological factors shall be considered in the causation of dumping syndrome from Ayurveda viewpoint.

–        Vata aggravating factors and Pitta aggravating factors – Early Dumping Syndrome
–        Kapha aggravating factors – Late Dumping Syndrome
–        Individual and relative imbalance between Samana Vayu, Pachaka Pitta and Kledaka Kapha
–        Relative imbalance between Samana Vayu and Apana Vayu
–        Causative factors of Agnimandya, Ajirna
–        Causative factors of Udavarta, Anaha, Adhmana
–        Causative factors of Alasaka and Vilambika
–        Causative factors of Atisara and Grahani roga
–        Vataja or Kaphaja Atisara or Grahani
–        Excessive consumption of water or food or irregular consumption of foods
–        Excessive consumption of ‘heavy or hard to digest’ foods
–        Excessive consumption of Katu – pungent or Madhura – sweet foods

Ayurveda Treatment Principles of Dumping Syndrome

Nidana Parivarjana – The causative factors of dumping syndrome shall be avoided / kept away.

Managing Agni Vaishamya – The imbalances of Agni should be addressed and treated accordingly.

Prompt treatment of dosha imbalances – The doshas of the gastrointestinal tract responsible for causation of dumping syndrome should be balanced.

Vata Anulomana and Snehana – Vata should be pushed into its normal course and direction with the help of Vata Anulomana herbs and formulations. Unctuous medicines and foods will be useful.

Prompt treatment of responsible / causative disease conditions – Diseases including agnimandya, ajirna, atisara, grahani, udavarta, visuchika, alasaka and vilambika etc should be promptly treated.

Following food discipline – One should take proper quality and quantity of food and at the right times. One should follow Ahara Vidhi Vishesha Ayatanani – rules and regulations of taking food as described in Ayurveda.

Making proper lifestyle corrections – One should indulge in proper exercises in terms of quality and quantity, should not forcibly withhold the natural urges of the body, should not create artificial urges when not manifested, should have good control over stress and emotional swings and should keep away from viruddha ahara – incompatible and unwholesome food combinations and wrong habits and addictions.

Skillful use of Panchakarma procedures – Timely and skillful administration of vamana, virechana or vasti as and when needed, as per the behavior of the gut will help in resolving long-term dumping syndrome.